Question 1

Robert is a 72-year-old patient who has hypertension and angina. He is at risk for common medication practices seen in the elderly including:

Accepted Answer

A)  Use of another person's medications 
B)  Hoarding medications 
C)  Changing his medication regimen without telling his provider 
D)  All of the above 
A)  Use of another person's medications 
B)  Hoarding medications 
C)  Changing his medication regimen without telling his provider 
D)  All of the above D

Question 2

Which of the following is not consistent with the rules for geriatric prescribing:

Accepted Answer

A)  Half-life will be longer in older adults 
B)  Steady state is reached more quickly in the older adult 
C)  Reduce the number of drugs in the patient's regimen whenever possible 
D)  Adverse drug responses present atypically in the older adult 
A)  Half-life will be longer in older adults 
B)  Steady state is reached more quickly in the older adult 
C)  Reduce the number of drugs in the patient's regimen whenever possible 
D)  Adverse drug responses present atypically in the older adult B

Question 3

You are reviewing the data from several meta-analyses that addressed the most common causes of adverse drug reactions in the older adult. Which of the following would you find to be decreased and the most common cause of these problems in older adults?

Accepted Answer

A)  Body fat content 
B)  Liver function 
C)  Renal function/clearance 
D)  Plasma albumin levels 
A)  Body fat content 
B)  Liver function 
C)  Renal function/clearance 
D)  Plasma albumin levels C

Question 4

Delta is an 88-year-old patient who has mild low-back pain. What guidelines should be followed when prescribing pain management for Delta?

Accepted Answer

A)  Keep the dose of oxycodone low to prevent development of tolerance. 
B)  Acetaminophen is the first-line drug of choice. 
C)  Avoid prescribing NSAIDs. 
D)  Add in a short-acting benzodiazepine for a synergistic effect on pain. 
A)  Keep the dose of oxycodone low to prevent development of tolerance. 
B)  Acetaminophen is the first-line drug of choice. 
C)  Avoid prescribing NSAIDs. 
D)  Add in a short-acting benzodiazepine for a synergistic effect on pain.

Question 5

The GFRs for a 91-year-old woman who weighs 93 pounds and is 5'1" with a serum creatinine of 1.1, and for a 202-pound, 25-year-old male who is 5'9" with the same serum creatinine according to the Cockcroft Gault formula are:

Accepted Answer

A)  25ml/ min and 133 mL/min respectively 
B)  25 mL/min and 103 mL/min respectively 
C)  22 ml/min and 133 mL/min respectively 
D)  22 ml/min and 103 mL/min respectively 
A)  25ml/ min and 133 mL/min respectively 
B)  25 mL/min and 103 mL/min respectively 
C)  22 ml/min and 133 mL/min respectively 
D)  22 ml/min and 103 mL/min respectively

Question 6

All of the following statements about the Beer's List are true except:

Accepted Answer

A)  It is a list of medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available. 
B)  It is derived from the expert opinion of one geriatrician and is not evidence-based. 
C)  These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long-term care facilities. 
D)  These criteria are directed at the general population of patients over 65 years of age and do not take disease states into consideration. 
A)  It is a list of medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available. 
B)  It is derived from the expert opinion of one geriatrician and is not evidence-based. 
C)  These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long-term care facilities. 
D)  These criteria are directed at the general population of patients over 65 years of age and do not take disease states into consideration.

Question 7

When an elderly diabetic patient is constipated the best treatment options include:

Accepted Answer

A)  Mineral oil 
B)  Bulk-forming laxatives such as psyllium 
C)  Stimulant laxatives such as senna 
D)  Stool softeners such as docusate 
A)  Mineral oil 
B)  Bulk-forming laxatives such as psyllium 
C)  Stimulant laxatives such as senna 
D)  Stool softeners such as docusate

Question 8

To improve positive outcomes when prescribing for the elderly the nurse practitioner should:

Accepted Answer

A)  Assess cognitive functioning in the elder 
B)  Encourage the patient to take a weekly "drug holiday" to keep drug costs down 
C)  Encourage the patient to cut drugs in half with a knife to lower costs 
D)  All of the above 
A)  Assess cognitive functioning in the elder 
B)  Encourage the patient to take a weekly "drug holiday" to keep drug costs down 
C)  Encourage the patient to cut drugs in half with a knife to lower costs 
D)  All of the above

Question 9

Steps to avoid polypharmacy include:

Accepted Answer

A)  Prescribing two or fewer drugs from each drug class 
B)  Reviewing a complete drug history every 12 to 18 months 
C)  Encouraging the elderly patient to coordinate their care with all of their providers 
D)  Evaluating for duplications in drug therapy and discontinuing any duplications 
A)  Prescribing two or fewer drugs from each drug class 
B)  Reviewing a complete drug history every 12 to 18 months 
C)  Encouraging the elderly patient to coordinate their care with all of their providers 
D)  Evaluating for duplications in drug therapy and discontinuing any duplications

Question 10

A medication review of an elderly person's medications involves:

Accepted Answer

A)  Asking the patient to bring a list of current prescription medications to the visit 
B)  Having the patient bring all of their prescription, over-the-counter, and herbal medications to the visit 
C)  Asking what other providers are writing prescriptions for them 
D)  All of the above 
A)  Asking the patient to bring a list of current prescription medications to the visit 
B)  Having the patient bring all of their prescription, over-the-counter, and herbal medications to the visit 
C)  Asking what other providers are writing prescriptions for them 
D)  All of the above

Question 11

Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie?

Accepted Answer

A)  Increased volume of distribution 
B)  Decreased lipid solubility 
C)  Decreased plasma proteins 
D)  Increased muscle-to-fat ratio 
A)  Increased volume of distribution 
B)  Decreased lipid solubility 
C)  Decreased plasma proteins 
D)  Increased muscle-to-fat ratio

Question 12

In geriatric patients, the percentage of body fat is increased. What are the pharmacologic implications of this physiologic change?

Accepted Answer

A)  A lipid-soluble medication will be eliminated more quickly and not work as well. 
B)  A lipid-soluble medication will accumulate in fat tissue and its duration of action may be prolonged. 
C)  Absorption of lipid-soluble drugs is impaired in older adults. 
D)  The bioavailability of the lipid-soluble drug will be increased in older adults. 
A)  A lipid-soluble medication will be eliminated more quickly and not work as well. 
B)  A lipid-soluble medication will accumulate in fat tissue and its duration of action may be prolonged. 
C)  Absorption of lipid-soluble drugs is impaired in older adults. 
D)  The bioavailability of the lipid-soluble drug will be increased in older adults.

Question 13

Principles of prescribing for older adults include:

Accepted Answer

A)  Avoiding prescribing any newer high-cost medications 
B)  Starting at a low dose and increasing the dose slowly 
C)  Keeping the total dose at a lower therapeutic range 
D)  All of the above 
A)  Avoiding prescribing any newer high-cost medications 
B)  Starting at a low dose and increasing the dose slowly 
C)  Keeping the total dose at a lower therapeutic range 
D)  All of the above

Question 14

Glen is an 82-year-old patient who needs to be prescribed a new drug. What changes in elimination should be taken into consideration when prescribing for Glen?

Accepted Answer

A)  Increased glomerular filtration rate (GFR) will require higher doses of some renally excreted drugs. 
B)  Decreased tubular secretion of medication will require dosage adjustments. 
C)  Thin skin will cause increased elimination via sweat. 
D)  Decreased lung capacity will lead to measurable decreases in lung excretion of drugs. 
A)  Increased glomerular filtration rate (GFR) will require higher doses of some renally excreted drugs. 
B)  Decreased tubular secretion of medication will require dosage adjustments. 
C)  Thin skin will cause increased elimination via sweat. 
D)  Decreased lung capacity will lead to measurable decreases in lung excretion of drugs.

Question 15

Robert is complaining of poor sleep. Medications that may contribute to sleep problems in the elderly include:

Accepted Answer

A)  Diuretics 
B)  Trazodone 
C)  Clonazepam 
D)  Levodopa 
A)  Diuretics 
B)  Trazodone 
C)  Clonazepam 
D)  Levodopa

Exam 51: Geriatric Patients

Robert is a 72-year-old patient who has hypertension and angina. He is at risk for common medication practices seen in the elderly including:

Which of the following is not consistent with the rules for geriatric prescribing:

You are reviewing the data from several meta-analyses that addressed the most common causes of adverse drug reactions in the older adult. Which of the following would you find to be decreased and the most common cause of these problems in older adults?

Delta is an 88-year-old patient who has mild low-back pain. What guidelines should be followed when prescribing pain management for Delta?

The GFRs for a 91-year-old woman who weighs 93 pounds and is 5'1" with a serum creatinine of 1.1, and for a 202-pound, 25-year-old male who is 5'9" with the same serum creatinine according to the Cockcroft Gault formula are:

All of the following statements about the Beer's List are true except:

When an elderly diabetic patient is constipated the best treatment options include:

To improve positive outcomes when prescribing for the elderly the nurse practitioner should:

Steps to avoid polypharmacy include:

A medication review of an elderly person's medications involves:

Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie?

In geriatric patients, the percentage of body fat is increased. What are the pharmacologic implications of this physiologic change?

Principles of prescribing for older adults include:

Glen is an 82-year-old patient who needs to be prescribed a new drug. What changes in elimination should be taken into consideration when prescribing for Glen?

Robert is complaining of poor sleep. Medications that may contribute to sleep problems in the elderly include:

The Role of the Nurse Practitioner

Review of Basic Principles of Pharmacology

Rational Drug Selection

Legal and Professional Issues in Prescribing

Adverse Drug Reactions

Factors That Foster Positive Outcomes

Cultural and Ethnic Influences in Pharmacotherapeutics

An Introduction to Pharmacogenomics

Nutrition and Nutraceuticals

Herbal Therapy and Nutritional Supplements

Information Technology and Pharmacotherapeutics

Pharmacoeconomics

Over-The-Counter Medications

Drugs Affecting the Autonomic Nervous System

Drugs Affecting the Central Nervous System

Drugs Affecting the Cardiovascular and Renal Systems

Drugs Affecting the Respiratory System

Drugs Affecting the Hematopoietic System

Drugs Affecting the Immune System

Drugs Affecting the Gastrointestinal System

Drugs Affecting the Endocrine System

Drugs Affecting the Reproductive System

Drugs Affecting the Integumentary System

Drugs Used in Treating Infectious Diseases

Drugs Used in Treating Inflammatory Processes

Drugs Used in Treating Eye and Ear Disorders

Anemia

Chronic Stable Angina and Low-Risk Unstable Angina

Anxiety and Depression

Asthma and Chronic Obstructive Pulmonary Disease

Contraception

Dermatologic Conditions

Diabetes Mellitus

Gastroesophageal Reflux and Peptic Ulcer Disease

Headaches

Heart Failure

Human Immunodeficiency Virus Disease and Acquired Immunodeficiency Syndrome

Hormone Replacement Therapy and Osteoporosis

Hyperlipidemia

Hypertension

Hyperthyroidism and Hypothyroidism

Pneumonia

Smoking Cessation

Sexually Transmitted Infections and Vaginitis

Tuberculosis

Upper Respiratory Infections, Otitis Media, and Otitis Externa

Urinary Tract Infections

Women As Patients

Men As Patients

Children As Patients

Pain Management: Acute and Chronic Pain

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